=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346591617
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHALIE VINASCO MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2012
-----------------------------------------------------
Last Update Date | 06/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1140 W 50TH ST STE 303
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-231-3371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8650 NW 97TH AVE APT 213
-----------------------------------------------------
City | MEDLEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33178-2577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-301-0361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SZ9551
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------